Patients Get More Unnecessary Scans from Doctors Who Own Equipment

From the editors and reporters of Scientific American , this blog delivers commentary, opinion and analysis on the latest developments in science and technology and their influence on society and policy. From reasoned arguments and cultural critiques to personal and skeptical takes on interesting science news, you'll find a wide range of scientifically relevant insights here. Follow on Twitter @sciam.

Katherine Harmon Courage is a freelance writer and contributing editor for Scientific American. Her book Octopus! The Most Mysterious Creature In the Sea is out now from Penguin/Current. Follow on Twitter @KHCourage.

More and more physicians are investing in their own imaging equipment. But when a doctor stands to make money on each MRI he or she orders, it doesn’t take a brain surgeon to figure out that they might be inclined to order too many scans.

Patients with back problems whose orthopedic surgeons referred them for an MRI were much more likely to have their spinal lumbar scan come back clean—indicating that the test might not have been necessary—if their doc had a financial stake in the equipment being used, than if he or she didn’t, according to new findings that were presented this week at the Radiological Society of North America’s annual meeting in Chicago.

“It is important for patients to be aware of the problem of self-referral and to understand the conflict of interest that exists when their doctor orders an imaging exam and then collects money on that imaging exam,” said Ben Paxton, a radiology resident who led the study at Duke University Medical Center in a prepared statement.

Of 250 spine lumbar MRIs ordered by orthopedic surgeons who had financial interest in the imaging equipment, 106 scans came back negative—that is, without serious abnormalities. Of the 250 lumbar MRIs ordered by orthopedic surgeons in the same area who would not see an extra penny from the scans, 57 came back negative.

Scans that did find problems seemed to be of equal severity in both groups, suggesting that the doctors should be referring roughly equal portions of patients for MRIs.

The two patient groups did show one interesting difference, however. Doctors with financial interest in the equipment “were much more likely to order MRI exams on younger patients,” Paxton said. The mean age for patients getting an MRI from these physicians was about 50, whereas the disinterested docs’ patients were closer to 57. That means the physicians with financial incentives might have different threshold altogether for recommending an MRI, he suggested.

The new findings suggest that studying these detailed correlation can help shape more effective health care cost cuts. Medical imaging overall cost Medicare some $14.1 billion in 2006—about twice as much as in 2000, according to a 2008 U.S. Government Accountability Office report. About $3.9 billion of that was from physicians who referred patients for imaging in their own offices, according to a July Journal of the American College of Radiology paper, co-authored by Ramsey Kilani, also of Duke, who worked on the new study as well.

“Attempts to date at reducing health care spending on medical imaging have come in the form of across-the-board cuts that threaten to reduce access to vital imaging services,” Kilani said. “We believe patients would be better served if we instead eliminated underlying drivers of unnecessary imaging spending.” Reducing doctor ownership of these scanners might be difficult in the short-term. So as these income-generating machines proliferate in physicians’ portfolios, the next time your doctor orders an MRI, it might be worth asking about the financial arrangement—or getting a second opinion from a doctor who hasn’t invested in equipment.

About the Author: Katherine Harmon Courage is a freelance writer and contributing editor for Scientific American. Her book Octopus! The Most Mysterious Creature In the Sea is out now from Penguin/Current. Follow on Twitter @KHCourage.

Total fluff. Doctors (and their Insurance carriers) get sued (sp?) every day because ‘they’ didn’t find “something.” Most tests are ‘CYA’ driven; and who can blame them? Their only protection? Tests and more tests, and the ‘results’ if they’re sitting in front of a Jury and a multi-million dollar law ….

In some ‘specialization, God Help you with the Premium; you could be paying up $200,000/yr.

People seem to forget, and their Atty’s don’t care if the money is big enough. Are some Doctor’s ‘quacks?; probably but they’re one out of a hundred thousand. Do a Goggle and see how many years it takes just to get the letters “MD” behind your name.
Just my .02 cents.
fae

“Total fluff. Doctors (and their Insurance carriers) get sued (sp?) every day because ‘they’ didn’t find “something.” Most tests are ‘CYA’ driven; and who can blame them? Their only protection? Tests and more tests, and the ‘results’ if they’re sitting in front of a Jury and a multi-million dollar law ….”

I think your claim is total fluff, a myth perpetrated by doctors and individuals who are inclined to buy their doctors’ lame excuses. It is easy to say an unnecessary test was ordered to avoid a lawsuit, but was it so? How many doctors order unnecessary tests to generate revenue and how many doctors order unnecessary tests to CYAs? Feel free to give your professional estimate or cite a reliable source.

You also said,

“In some ‘specialization, God Help you with the Premium; you could be paying up $200,000/yr.”

I suggest you do an Internet study on liability insurance premiums by discipline and location. You will find great variation. An obstetrician in Dade County, for example, pays considerably more than an obstretrician in Springfield, Mo.

I am accustomed to the fearsome claim and insidious inference that malpractice insurance costs every doctor a ton of money. That is simply not the case. Someone should publish comprehensive nationwide statistics to finally put an end to such nonsense.

Your comments are useful so far as they indicate fertile ground for objective data collection and government regulation. The idea that doctors and health insurance providers should be free to rip off patients should be exposed as a pernicious cultural fraud.

anyone know what an mri cost these days….everyone is talking like its thousands of dollars(if not tens of thousands)…
I think but am not sure that its in the range of 250 US…anyone with some recent costs out there?